Page 174 - Clinical Application of Mechanical Ventilation

140 Chapter 5

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A B

Figure 5-11 After placement of the pharyngealtracheal lumen airway, both cuffs are inflated. (A)
When the tube enters the esophagus, lumen No. 1 is used to ventilate the patient via the openings
between the cuffs. (B) When the tube enters the trachea, lumen No. 2 is used to provide ventilation
directly into the trachea.

is absent or poor, lumen 2 should be used to provide ventilation, as the distal end of
the ETC is likely in the trachea.
If ventilation is poor with lumens 1 and 2, a cuff leak may be present. This prob-
lem may be corrected by inflating the proximal cuff with more air. Try lumen 1
again and check for adequacy of ventilation. If ventilation is still poor, the entire
procedure described earlier can be repeated after preoxygenating the patient.
Complications of ETC

Cases of complications associated with the use of the ETC have been reported.
These complications are related to either hemodynamic stress or air leaks. In one
report, the hemodynamic and catecholamine stress response after insertion of the
ETC were significantly higher compared to laryngeal mask airway or endotracheal
intubation. This observation might be attributed to the pressure of the pharyngeal
cuff of the ETC (Oczenski et al., 1999). In another report, different types of air leak
(subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum) were
observed as a result of using the ETC. Esophageal laceration appears to be the cause
of these air leaks (Richards, 1998; Vézina et al., 1998).

DOuBLE-LuMEN ENDOBRONChIAL TuBE (DLT)

double-lumen endobronchial The double-lumen endobronchial tube (DLT) has two separate lumens (tracheal
tube: A special airway for inde- and bronchial), two cuffs (tracheal and bronchial), and two pilot balloons (tracheal
pendent lung ventilation. It has
two separate lumens, two cuffs, and bronchial). It is also known as the double-lumen tracheobronchial tube and
and two pilot balloons.
may be either a left- or right-sided tube.

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